Dedicated 70 MHz RF systems for hyperthermia of challenging tumor locations

Hyperthermia (i.e. heating of tumor tissue to 40-43°C) is used in clinical oncology to enhance the therapeutic effect of chemotherapy and radiotherapy. Many tumor sites are heated either by a single RF or MW antenna positioned on the tumor location, or by a phased array positioned around the patient. Superficial tumors are generally heated with MW antennas (434-2450 MHz) and deep-seated tumors with RF antennas (70-150 MHz). These devices cover the major, more common tumor sites, but more rare locations require more dedicated applicators. We discuss dedicated RF systems aiming for heating semi-deep-seated tumors in the leg, breast, and upper thorax. Clinical results show that adequate heating is possible with these systems, with achieved temperatures in the therapeutic range

Technical and Clinical Evaluation of the ALBA-4D 70MHz Loco-Regional Hyperthermia System

Hyperthermia, increasing tumor temperatures to 39-43°C for 1 h, enhances the effectiveness of radiotherapy and chemotherapy. Deep seated pelvic tumors are usually heated by arrays of radiofrequency or microwave antennas placed around the patient, capable of focussing power onto the tumor. The AMC developed the AMC 4 loco-regional hyperthermia system with 4 rectangular 70 MHz waveguide antennas for heating deep-seated pelvic tumors. This system has been commercialized as the ALBA4D utilizing the same geometric layout and the same waveguides. Goal of this study was to evaluate the performance of the ALBA4D system. We compared electric field (E-field) distributions in a patient-mimicking phantom and confirmed that phase control of the focal point is similar to the AMC 4, thus ensuring similar clinical performance

Experimental validation of a thermophysical fluid model for use in a hyperthermia treatment planning system

Accurate hyperthermia treatment planning, monitoring, and evaluation of temperatures in and near fluid volumes in the body requires realistic modelling of heat transport within fluids, which is currently not implemented in available treatment planning packages. Aim of this study is to assess the accuracy of a thermophysical fluid model, developed for treatment planning near fluid volumes. A cubic phantom with inner dimensions of (7 cm) 3 was filled with deionised water. The front, back, top and bottom walls of the cube consisted of PVC, the side walls of stainless steel. The left wall was kept at a constant temperature of 25 or 37 °C, the right wall at 1, 2, 5, 10, or 15 °C higher. Thermal probes mapped the temperature profile in the central vertical plane perpendicular to the cold and hot walls with a spatial resolution of 5–10 mm. The temperature distributions were compared to simulations using a finite volume-based thermophysical fluid model implementing the Boussinesq approximation to the Navier-Stokes equations, developed as an extension to our in-house developed hyperthermia treatment planning suite. The simulations were performed using three meshes at different resolutions. The fluid model predicts the temperature distribution accurately (random and systematic error <0.1 °C, at least 95% of absolute errors <0.2 °C) for hyperthermic temperature differences (<5 °C within the fluid volume). When the temperature differences reach 15 °C, the random and systematic errors increase to 0.3 °C and 0.1 °C, respectively, with absolute errors up to 1.1 °C. The thermophysical fluid model predicts temperature distributions in a convective fluid with sufficient accuracy for hyperthermia treatment planning in and near fluid regions. A mesh with a resolution of 0.25 cm combines accurate results with acceptable computation times

Two high-resolution thermal monitoring sheets for clinical superficial hyperthermia

Temperature measurement during superficial hyperthermia is limited by poor spatial resolution. We investigated two sheets to improve temperature monitoring of the skin surface. Two different sheets were studied with a grid of temperature sensors with one sensor per ∼5 cm2. The first was a matrix of multisensor thermocouple probes laced through a silicone sheet. The second sheet had rows of thermistors connected by meandering copper leads mounted on stretchable printed circuit board (SPCB). Accuracy, temperature resolution and two hour stability of both sheets were investigated. Furthermore, we determined the ability to follow body contours, thermal conduction errors and electromagnetic (EM) compatibility to clinically used 434 and 915 MHz hyperthermia applicators. For both sheets the accuracy (≤0.2C), temperature resolution (≤0.03C) and stability (≤0.01C hr-1) were adequate for clinical use. Thermal conduction errors ranged from 5.25-11.25 mm vs. 2.15 mm for the thermocouple probe and thermistor, respectively. Both sheets could follow body contours, where the ratio air/water bolus surface was <5%. When aligned perpendicularly to the EM field the meandering copper tracks used on the SPCB did induce self-heating, while the thermocouple probes did not. Self-heating had a linear relationship with the angle of the leads with respect to the EM field direction for both sensors at both frequencies. Self-heating of the thermistor was similar for both frequencies, while it was circa two-fold higher for 915 vs. 434 MHz for the thermocouple. The use of SPCB technology for skin surface monitoring was promising. However, suppressing self-heating induced by the horseshoe shaped copper tracks needed for stretchability of the SPCB requires more in-depth investigation. The thermocouple matrix was the most promising for clinical application, meeting 6/7 of the major requirements for skin surface temperature monitoring when positioned perpendicular to the EM field

Clinical feasibility of a high-resolution thermal monitoring sheet for superficial hyperthermia in breast cancer patients

Background: Accurate monitoring of skin surface temperatures is necessary to ensure treatment quality during superficial hyperthermia. A high-resolution thermal monitoring sheet (TMS) was developed to monitor the skin surface temperature distribution. The influence of the TMS on applicator performance was investigated, feasibility and ability to reliably monitor the temperature distribution were evaluated in a clinical study. Methods: Phantom experiments were performed to determine the influence of the TMS on power deposition patterns, applicator efficiency, and heat transfer of the water bolus for 434 and 915 MHz applicators. Clinical feasibility was evaluated in 10 women with locoregional recurrent breast cancer. Skin surface temperatures during consecutive treatments were monitored alternatingly with either standard Amsterdam UMC thermometry or TMS. Treatments were compared using (generalized) linear mixed models. Results: The TMS did not significantly affect power deposition patterns and applicator efficiency (1–2%), the reduced heat transfer of the water boluses (51–56%) could be compensated by adjusting the water bolus flow. Skin surface temperatures were monitored reliably, and no alteration of thermal toxicity was observed compared to standard Amsterdam UMC thermometry. Conclusion: Clinical application of the TMS is feasible. Power deposition patterns and applicator efficiency were not affected. Surface temperatures were monitored reliably

Comparison of the clinical performance of a hybrid Alba 4D and the AMC-4 locoregional hyperthermia systems

Objective: The in-house developed 70 MHz AMC-4 locoregional hyperthermia system has been in clinical use since 1984. This device was recently commercialized as the Alba 4D (Medlogix®, Rome, Italy), with a similar geometrical 4-waveguide design. At the time of this study a hybrid Alba 4D was installed at our center, which incorporated elements of the AMC-4. This study aims to compare clinical performance of both devices. Methods: During one year after clinical acceptance of the hybrid Alba 4D, both devices were used for treatment delivery in patients scheduled for locoregional hyperthermia. Each patient started with the AMC-4, next sessions were allocated to either device. Possible differences between Alba 4D and AMC-4 sessions in power, achieved temperature T0, T10, T50, T90, T100, treatment time and complaints per session, were evaluated using linear mixed models (LMMs) for repeated measures with patient as random effect. Results: From March 2018 to April 2019, eleven patients with cervical, pancreatic, vaginal carcinoma and uterine leiomyosarcoma received 27 locoregional hyperthermia sessions with the Alba 4D and 34 sessions with the AMC-4. Median number of sessions per patient was 5 (range 3–13). Treatment results for both devices were not significantly different: T50 was 40.5 ± 1.0 °C vs. 40.8 ± 0.7 °C, applied power was 500 ± 79 W vs. 526 ± 108 W, for the Alba 4D vs. AMC-4, respectively. Conclusion: Results of the first patients treated with the hybrid Alba 4D demonstrated comparable clinical performance of the Alba 4D and AMC-4 locoregional hyperthermia systems, and both devices are expected to yield similar favorable clinical results

Validation of thermal dynamics during Hyperthermic IntraPEritoneal Chemotherapy simulations using a 3D-printed phantom

Introduction: CytoReductive Surgery (CRS) followed by Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) is an often used strategy in treating patients diagnosed with peritoneal metastasis (PM) originating from various origins such as gastric, colorectal and ovarian. During HIPEC treatments, a heated chemotherapeutic solution is circulated through the abdomen using several inflow and outflow catheters. Due to the complex geometry and large peritoneal volume, thermal heterogeneities can occur resulting in an unequal treatment of the peritoneal surface. This can increase the risk of recurrent disease after treatment. The OpenFoam-based treatment planning software that we developed can help understand and map these heterogeneities. Methods: In this study, we validated the thermal module of the treatment planning software with an anatomically correct 3D-printed phantom of a female peritoneum. This phantom is used in an experimental HIPEC setup in which we varied catheter positions, flow rate and inflow temperatures. In total, we considered 7 different cases. We measured the thermal distribution in 9 different regions with a total of 63 measurement points. The duration of the experiment was 30 minutes, with measurement intervals of 5 seconds. Results: Experimental data were compared to simulated thermal distributions to determine the accuracy of the software. The thermal distribution per region compared well with the simulated temperature ranges. For all cases, the absolute error was well below 0.5°C near steady-state situations and around 0.5°C, for the entire duration of the experiment. Discussion: Considering clinical data, an accuracy below 0.5°C is adequate to provide estimates of variations in local treatment temperatures and to help optimize HIPEC treatments